When You Need to Take Time Off Work for Mental Health Reasons

Personal health should be a private matter. But when you need to take time off work due to a mental health condition, often it isn’t possible to maintain that privacy. As a board member at the National Alliance on Mental Illness (NAMI), and a former managing director at two global banks (UBS and Deutsche Bank), I’ve been approached by hundreds of colleagues and clients over the past 30 years seeking advice for themselves or a colleague, friend, or family member on how best to manage professional life while dealing with a mental health condition themselves or caring for a loved one who is. Here is what I usually tell them.

While workplace culture is not the cause of an illness, certain cultures, especially those that require employees to work long hours in sedentary conditions, can make an illness difficult to manage. Lack of adequate sleep, an inability to maintain an exercise routine, loss of time with friends and loved ones, or substance misuse can lead to deteriorating mental health, which can make it hard to keep up at work.

If you need to take a leave of absence, ideally you’d be able to calmly inform your manager or HR department that you need to go on leave, while sharing only a minimal amount of information and keeping your diagnosis private. For a longer-term disability leave, as opposed to a normal sick leave, your doctor will likely need to provide documentation to your firm’s disability insurance provider. The disability provider acts as an intermediary between you and your employer and does not share your diagnosis with your employer. The provider would then evaluate information about your health status and make recommendations regarding when you can return to work.

It’s important to know your rights and your company’s policies. In the U.S., the Americans with Disabilities Act (ADA) makes it illegal to discriminate against an employee with a mental health issue. Many conditions, such as bipolar disorder, major depression, and post-traumatic stress, are covered under the ADA, but it does not provide blanket protection. The federal Equal Employment Opportunity Commission (EEOC) provides guidance on the rights and obligations of employers and employees and can be a good source of information for those in the U.S.

Once you’ve negotiated your leave and gotten the help you need, a big question is how to return to work: What do you tell coworkers? Your boss? How do you get back into the swing of things without compromising your health? Of course, no two paths will be the same.

Start by weighing the pros and cons of being open about a diagnosis. Many people have physical or mental health issues and opt not to tell their coworkers or employers about them. The law is on your side here. The EEOC says the returning employees may keep their diagnosis private in most situations. But, of course, your manager may already know about your condition if you involved them in taking the leave of absence.

In my experience, there are typically two types of people who will disclose, despite the fear of prejudice or discrimination at work. The first group is those who want to bring their whole selves to work and don’t want to hide. The second group includes leaders, either in title or in practice, who understand that openly acknowledging their diagnosis can shed a positive light on what it means to work with someone with a mental, or invisible, disability.

Regardless of whether you disclose, prepare for colleagues’ questions about your absence. A brief and consistent narrative will help you stay focused on readjusting to work. You might say something like, “I took time off for health [or personal] reasons, but things are fine now and I’m happy to be back to work.”

Consider whether you should go back full-time right away or part-time at first. Dealing with a mental illness can be exhausting, so give yourself the time you need. Reintegrate into your larger social circle with the same measured pace. And consider the impact of any medications you might be taking. Some might make you drowsy, so see if you can shift your hours to avoid working at your most tiring periods. Over time, your psychiatrist may want to adjust your medications to optimally manage your brain chemistry. It can be days, weeks, or months before you and your doctor can tell if the medication and dosage are right for you. During this transition time, you may experience physical reactions or mood swings.

Develop a personal mantra to help you transition back: “Be compassionate to myself.” “I’m on a learning curve.” “Take it a few hours at a time.” Rely on your support system — an empathetic family member, a close friend, a doctor or therapist, and perhaps a trusted colleague at work. They can provide insight into your behavior that can prevent the onset or reduce the seriousness of your illness.

Stick to a routine, whenever possible. Find a quiet place where you can take short breaks, or even meditate, during the day. Before you go home, make a brief list of the next day’s priorities. Think through how you will manage business travel that involves crossing time zones; jet lag can cause backsliding.

In the evening, jot down a few positive things that happened during the day. Journaling can help you track your moods and behavior and can help your psychiatrist calibrate your medications.

To prevent setbacks, learn to recognize the early warning signs. Are you stressed, anxious, or getting into conflicts at work? Keep in mind that there is a difference between a bad day and relapsing.

Finally, if you want to have a conversation with your boss or colleagues about your health, do it on your terms, when work is going well and you are in an unemotional state. You might make yourself more vulnerable with those you trust, but being able to share your diagnosis can help to dispel myths and reduce stigma. Talking about mental health, just as one would talk about physical health, sends a powerful message that it’s OK to get help.